Home Medizin Fallstricke, wenn sich Ihr Patient der reinen Telemedizin zuwendet

Fallstricke, wenn sich Ihr Patient der reinen Telemedizin zuwendet

von NFI Redaktion

Yalda Jabbarpour, MD, a primary care physician in Washington, D.C., has a sometimes months-long waitlist for patients. However, often patients have urgent symptoms, as was the case with a patient who turned to a Direct-to-Consumer (DTC) telemedicine company.

Her telemedicine physician diagnosed the patient with a urinary tract infection after hearing her symptoms of frequent and painful urination. The DTC physician didn’t request lab cultures, a follow-up appointment, or recommend that the patient visit Jabbarpour.

Over the next nine months, Jabbarpour’s patient sought help from other direct care companies, which prescribed medication to match her symptoms without advising her to see her primary care physician. The lack of coordination between the DTC physicians and Jabbarpour obscured a larger problem that could have been recognized earlier if the woman had seen a physician or at least had her medical records transferred.

After nine months, the patient finally went to her annual check-up with Jabbarpour, who made a new diagnosis: type 2 diabetes.

„When there’s no one there to put the picture together, it can be dangerous,“ said Jabbarpour, noting that while the patient’s diabetes could now be treated with medication, it took nearly a year for her insulin levels to normalize.

With the growing shortage of primary care physicians, many clinicians recognize that DTC models like Amazon Clinic and Hims & Hers Health can improve access to healthcare. However, many also fear that the lack of continuity between these purely online providers and on-site physicians can put patients at risk of missing a diagnosis or taking unnecessary medication, especially antibiotics.

Some primary care physicians are reconsidering their own care models to ensure that patients‘ needs are being met in a new era of healthcare.

A fragmented model

A recent University of Michigan survey found that while fewer than 8% of patients between the ages of 50 and 80 had used a DTC health platform, a third of those who did were prescribed a medication that their primary care physician was unaware of.

While the use of DTC platforms is currently low, over 42% of respondents aged 50-64 expressed interest in using pure online providers for medical care in the future.

Meanwhile, the American College of Physicians released a statement in early January expressing concern about DTC websites where physicians are busy prescribing medications. The statement followed the launch of LillyDirect by Eli Lilly, a digital pharmacy connecting patients with independent telemedicine providers who can prescribe the company’s medications, including its popular obesity medications.

„Telemedicine is most beneficial when it strengthens the relationship between patient and physician, but the direct care model does not do that,“ said Steven Furr, MD, a primary care physician in Alabama and president of the American Academy of Family Physicians.

Direct care models could be made safer if electronic records of these visits were passed on to the patient’s primary care provider, said Jabbarpour. If she had been informed of her patient’s recurring direct visits for a urinary tract infection, Jabbarpour could have identified the underlying problem earlier.

Physicians revamp their own care model

Nathaniel DeNicola, MD, a gynecologist at the Caduceus Medical Group in Orange County, California, has adjusted his private practice. He now keeps telemedicine emergency appointments available every day to provide patients with an alternative to DTC competitors.

„The promise of these telehealth options is to expand our necessary and still very important in-person care,“ he said. „Many patients say they use these companies in emergencies.“

He said that the pandemic pushed doctors to expand their virtual services to address key vulnerabilities in the healthcare system, including patients needing to book appointments weeks or months in advance.

„On-demand services are becoming the norm,“ he said, adding that in his experience, patients still desire a lasting relationship with a physician. „The future is a hybrid model.“

A recent American Medical Association survey found that nearly 75% of physicians stated that telemedicine will be part of their practice in 2023, nearly three times as many as in 2018. Some DTC services are also transitioning to a hybrid model. Amazon’s One Medical, a subscription-based primary care company, has formed partnerships with clinics that can offer in-person visits when telemedicine is not suitable.

DeNicola said that in his experience, the purely virtual direct care model can leave patients with questions or an understanding of the risks associated with medications such as certain types of birth control pills. Providing patients with a hybrid model for faster access to care can ensure the convenience of the direct-to-consumer model while ensuring that patients are treated in person when needed.

If a patient who previously received a birth control prescription wants to start again, the prescription can safely be provided through a telehealth service with their primary care physician who can view the patient’s electronic records, DeNicola said. However, for issues such as suspected vaginal infection, an in-person visit would be necessary.

Jabbarpour has also changed her model to better accommodate sudden health issues like urinary tract infections in patients who may not be able to be seen for weeks. She urges her patients to report any occurring problems through the patient portal so she can help determine the best course of action. Sometimes, Jabbarpour recommends a patient visit an urgent care clinic. In other cases, if a female patient has had the same health issue in the past, she prescribes medication that has worked in the past without requiring a visit.

„I understand the patients‘ viewpoint. They need care when they need care,“ she said.

Jabbarpour added that she has to respond to requests after her clinic hours in her free time. Most insurers do not pay for this time, she said, so she does not recommend other physicians to work around the clock.

Kaitlin Sullivan is a health, science, and environmental journalist.

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